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Form 5316 (6-2011)
Page
Yes
No
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Is the group trust adopted as part of each adopting group trust retiree benefit plan? (See instructions.)
Does the group trust instrument expressly limit participation to: pension, profit-sharing, and stock bonus trusts
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or custodial accounts qualifying under section 401(a) that are exempt under section 501(a); individual
retirement accounts that are exempt under section 408(e); eligible governmental plan trusts or custodial
accounts under section 457(b) that are exempt under section 457(g); custodial accounts under section
403(b)(7); retirement income accounts under section 403(b)(9); and section 401(a)(24) governmental plans?
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Does the group trust instrument expressly prohibit any part of its corpus or income that equitably belongs to
any adopting group trust retiree benefit plan from being used for, or diverted to, any purpose other than for the
exclusive benefit of the participants and the beneficiaries of the group trust retiree benefit plan?
Is each group trust retiree benefit plan entity which adopts the group trust itself a trust, a custodial account, or
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a similar entity that is tax-exempt under section 408(e) or section 501(a) (or is treated as tax-exempt under
section 501(a))?
Does each group trust retiree benefit plan which adopts the group trust expressly provide in its governing
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document that it is impossible for any part of the corpus or income of the group trust retiree benefit plan to be
used for, or diverted to, purposes other than for the exclusive benefit of the plan participants and their
beneficiaries?
Does the group trust instrument expressly limit the assets that may be held by the group trust to assets that
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are contributed by, or transferred from, a group trust retiree benefit plan to the group trust (and the earnings on
such assets), and does the group trust instrument expressly provide for separate accounts (and appropriate
records) to reflect the interest which each adopting group trust retiree benefit plan has in the group trust?
Does the group trust instrument expressly prohibit an assignment by an adopting group trust retiree benefit
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plan of any part of its equity or interest in the group trust?
Was the group trust created or organized in the United States and is the group trust maintained at all times as
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a domestic trust in the United States?
5316
Form
(6-2011)
49983G06201102